Mupfumi 2014.

Study characteristics
Methods	Single centre, pragmatic individually‐randomized controlled trial
Participants	Participants included were consecutive symptomatic and asymptomatic HIV‐infected participants initiating anti‐retroviral therapy 18 years old and older Female: 55% HIV infection: 100% (HIV clinic) Setting: specialized infectious disease hospital Country: Zimbabwe Sample size: 424
Interventions	participants provided 2 spot sputum specimens at least 1 hour apart. If participants were unable to expectorate sputum, attempts were made to induce sputum using nebulized 6% hypertonic saline. Samples in the microscopy group had a direct smear completed on each sample followed by staining with auramine O (Leica, Germany). Xpert MTB/RIF assays were completed on direct sputum.
Outcomes	Primary outcome: proportion of participants who were diagnosed with ART‐associated tuberculosis, or who died within 3 months of randomization
Notes	Target condition: Tuberculosis Case definition: participants with at least 1 positive Xpert or microscopy (for 'scanty' samples, both smears needed to be recorded as 'scanty')
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Allocation list was generated by the data manager and supplied to the laboratory manager in sealed envelope
Allocation concealment (selection bias)	Low risk	Allocation was given in sealed opaque envelope
Baseline characteristics similar (selection bias)	Low risk	Similar baseline characteristics in both groups
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding was not done. Blinding was not feasible given a pragmatic trial design, however, sample transporter to the central laboratory for quality control was blinded to participant identification
Protection against contamination (performance bias)	Low risk	Randomization was generated by a data manager, and codes were kept in envelopes; participants were assigned based on codes.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Blinding was not feasible; death occurring after tuberculosis diagnosis was considered tuberculosis‐related death, however, the authors did not clearly explain the different ways to verify death.
Incomplete outcome data (attrition bias) All outcomes	Low risk	The proportion of loss to follow‐up was not significantly different between groups
Selective reporting (reporting bias)	Low risk	All outcomes in the methods were reported
Other bias	Low risk	Not detected